Persons with diabetes can live a full life by following a few basic principles to control their disease. Diabetes can be managed with at-home blood glucose tests, healthy nutrition habits, weight control, routine exercise, and medications (if needed).

The most important step is to learn to control the blood sugar value, which means maintaining it as near to normal as possible or in the goal range determined by your physician.

Vigilant control of blood sugar levels may dramatically reduce the risk of eye, kidney, and nerve damage. This also lowers the risk of heart attack, stroke, and limb amputation, in addition to pro moting a more desirable level of blood lipids.

Blood sugar can be kept within normal levels by balancing the main treat ment tools for diabetes— nutrition, weight control, exercise, and medication. In some people, blood sugar may be controlled by a combination of weight loss, good nutrition, and regular exercise. Others may need medication.

Blood Sugar Levels

The level of glucose in the blood depends on several factors: when meals are eaten, how many calories are consumed, activity level, and the dose of medication prescribed. The stress of an illness may also alter the level of blood glucose. Successful daily management of diabetes may prevent or minimize emergencies that may result when blood sugar levels are too high or too low.

Because these emergencies can cause mental confusion or loss of consciousness, people with diabetes should wear a medical alert identification and acquaint family members, friends, neighbors, and coworkers with the signs and symptoms of an emergency and steps to a proper response.

Blood sugar levels can be monitored with home testing meters. Testing not only measures the amount of sugar in the blood but also enables the person to identify the reasons behind high and low values so that adjustments can be made in the dose of diabetes medications.

Frequently the person can learn how to adjust the dose of oral medication or insulin to achieve the desired glucose value. The health care team caring for the person with diabetes can determine reasonable blood sugar goals.

Nutrition

The old restrictive diets for diabetes no longer apply. It is now known that the best diet for diabetes control is consistent with what everyone should eat for good health. How much you eat is just as important as what you eat in controlling blood sugar.

To keep blood sugar on an even keel, people with diabetes should not eat large meals or skip meals; they should eat smaller servings at regular intervals instead. As for the menu, choices should follow Food Guide Pyramid recommendations—emphasize whole grains, legumes, and vegetables.

These foods are higher in complex carbohydrate and fiber and can help control blood sugar. Even though fruit contains sugar, it should not be avoided. Because people with diabetes are at higher risk for cardiovascular disease, it’s important to keep the fat intake to about 30 percent of total daily calories and to limit cholesterol-containing foods.

Items at the top of the Food Guide Pyramid—such as fats and sweets—should be eaten sparingly. Research has shown that the total amount of carbohydrate consumed at a given time, rather than the type of carbohydrate, is the most important factor in control of blood sugar.

Therefore, if not present in excess, sugar can be included as a part of a well-balanced meal. Many tools are available to help with meal planning. For most people, eating three meals at regular times and avoiding excessive sweets are enough to control blood sugar.

Dietitians may provide a simple method, such as the Food Guide Pyramid, to encourage variety, proportion, and moderation in food selections and to also ensure healthful food choices. Other techniques may be needed and recommended by your physician, registered dietitian, or certified diabetes educator.

Weight Control

Because many people who have diabetes are overweight, maintaining a healthful weight and level of activity is the key to keeping the disease under control and minimizing the risk for serious complications.

The more overweight people are, the more resistant their cells become to their own insulin; losing weight decreases that resistance. Often, weight loss of just 10 percent can improve blood sugar and have lasting beneficial effects.

Exercise

With exercise, some people with type 2 diabetes may even reduce or eliminate their need for insulin or oral diabetes medication. Anyone who has diabetes should check with a physician before starting an exercise program. Studies have shown that those at high risk for diabetes who exercise have a 50 percent lower incidence of type 2 diabetes.

Exercise helps control weight, makes cells more sensitive to insulin, increases blood flow, and improves circulation in even the smallest blood vessels. A leaner body also helps burn calories more efficiently. Moreover, exercise lowers your risk of cardiovascular disease.

Exercise can affect blood sugar levels up to 24 hours. So if insulin is a part of the treatment plan, check with a physician to receive guidelines for frequency of blood sugar testing and insulin adjustment.

Medications

Along with nutrition, weight control, and exercise, medications may be necessary to achieve a desired glucose level. Persons with type 1 diabetes must take insulin by injection. Insulin cannot be taken by mouth because it breaks down in the digestive tract. The type of insulin and number of daily injections depend on individual needs.

Insulin also can be administered by pump. In some persons, type 2 diabetes can be managed by healthful nutrition and exercise alone. If the desired glucose level is not achieved, oral medications may be prescribed. There are several classes of oral medications.

Some stimulate the pancreas to produce more insulin, and some help insulin to work more effectively in the body by decreasing the sugar made by the liver and by increasing the sugar removed from the blood to the cells. If oral medications do not achieve the glucose goal, insulin injections may be required.